Position statement on paediatric ... - BMJ Quality & Safety



Position statement on paediatric prescribing The Australian Commission on Safety and Quality in Health Care (the Commission) recommends that authorised prescribers clearly specify the following information on all prescriptions for children:Age and/or date of birth Current body weight Basis for the dose calculation such as, mg/kg, if appropriateDose in units of mass – for example, 150 mg per dose, given four times a day. Clinicians should review this information when prescribing, dispensing and administering medicines to children, and also:Check the appropriateness of the prescribed doseVerify all dose calculations (using a calculator) and the specified dose Discuss and clarify with parents and carers the reason for the medicine’s use, the correct dose and instructions for administration, and demonstrate how to measure and administer the dose, if required.NotesThese recommendations are not exhaustive. Use appropriate paediatric reference texts and guidelines for more detailed information on optimising paediatric prescribing, especially when dealing with special patient cohorts such as those with renal or hepatic impairment.Dosing in obese or overweight children – Dose calculations using ‘total body weight’ may result in overdosing for some medicines. Refer to paediatric reference texts and guidelines for advice on individual medicines. For older paediatric patients, or those over 40 to 50 kg, ensure that the upper dose limits for adults are not exceeded. It may not be applicable to specify the dose in units of mass in certain circumstances such as when prescribing eye drops, ear drops, topical products, inhalers, or insulin.Ensure that all prescribers are equipped with knowledge and skills in the core principles of safe prescribing and medicines use in the paediatric population.Rationale Medication errors are one of the most common and preventable adverse events in healthcare settings.1 Children are more prone to medication errors and are more vulnerable to harm from the effect of medication errors than adults.1,2,3 A worldwide systematic review has estimated 100 to 400 prescribing errors occur per 1,000 paediatric patients.4 Dose calculation errors are one of the most common types of medication error in children.2,5,6It is important to document the child’s weight and the basis for dose calculation in safe prescribing. These are included as required fields on the national inpatient medication chart (NIMC), and in electronic prescribing systems. There is currently no field to document weight on outpatient and community prescriptions, whether these are private or Pharmaceutical Benefits Scheme (PBS) prescriptions.Most dosing recommendations in paediatric reference materials are standardised by weight (mg/kg).5,7 The Institute for Safe Medication Practices, the American Academy of Pediatrics and other authoritative paediatric reference materials recommend recording weight on prescriptions for children.5,7,8,9 Patient age and accurate weight are essential to calculate the dose at the time of prescribing and to verify the dose during dispensing and/or administration. Documenting patient weight and age, and adopting good prescribing, dispensing and administration practices can prevent patient harm associated with dosing errors.ConsultationThis position statement is endorsed by the following organisations: Australian College of Nurse PractitionersAustralian Nursing and Midwifery Federation NPS MedicineWisePharmaceutical Society of AustraliaThe Royal Australian College of Physicians The Society of Hospital Pharmacists of AustraliaWomen’s and Children’s Healthcare AustralasiaThe Royal Australian College of General Practitioners and The Pharmacy Guild of Australia were represented on the working group and consulted in the statement development.Reference texts and resourcesAustralian Medicines Handbook Children’s Dosing CompanionAustralian Pharmaceutical Formulary and Handbook (APF24)Therapeutic GuidelinesSociety of Hospital Pharmacists of Australia Don’t Rush to Crush, 2nd editionBritish National Formulary for ChildrenAustralian Commission on Safety and Quality in Health Care. Recommendations for terminology, abbreviations and symbols used in medicines documentationAgency for Healthcare Research and Quality (US). Health literacy universal precautions toolkit, 2nd edition: use the teach-back method ReferencesJoint Commission. Preventing pediatric medication errors. Sentinel Event Alert 2008; issue 39.Benavides S, Huynh D, Morgan J, Briars L. Approach to the pediatric prescription in a community pharmacy. J Pediatr Pharmacol Ther 2011;16(4):298–307.Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285(16):2114–20.Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 2007;16(2):116–26.Australian Medicines Handbook. AMH children's dosing companion. Adelaide: Australian Medicines Handbook Pty Ltd; 2015.Doherty C, McDonnell C. Tenfold medication errors: 5 years’ experience at a university-affiliated pediatric hospital. Pediatrics 2012;129(5):916–24.Royal Pharmaceutical Society of Great Britain. British National Formulary for children. London: BMJ Publishing; 2017.Levine S, Cohen M, Blanchard N, Frederico F, Magelli M, Lomax C, et al. Guidelines for preventing medication errors in paediatrics. J Pediatr Pharmacol Ther 2001;6:426–42.American Academy of Pediatrics. Prevention of medication errors in the pediatric inpatient setting. Pediatrics 2003;112(2):431–6. ................
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